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Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

The Language of Leadership- Why Standards of Behavior are So Important
By Bob Murphy, RN, Esq.

Most organizations have a set of standards in place that we require our staff to demonstrate and follow. But do we spend enough time focusing on their importance? Our research tells us that those organizations that truly live their standards of behavior every day achieve better results. The senior leaders, managers, and directors (and, ideally, all staff) understand and use the standards of behavior in everyday conversation. It becomes a part of their language so much so that they don’t even realize they are using those words or practicing those behaviors.

Standards of behavior offer staff guidelines to demonstrate the same level of behavior on a daily basis. They serve as a commitment to how we will treat each other and those we interact with. They are so important to setting the tone of the organization that we recommend posting them for visitors to see. This further demonstrates the value those standards have to our organization.

As we think of opportunities to reinforce, teach, and recognize standards in our daily work, we can start by asking ourselves what “right” really looks like and then demonstrate our commitment to the standards by repeating those behaviors. We can share best practices during huddles or department meetings to create a culture that lives by the standards. A great example of an organization that excels in this area is Lafayette General Medical Center. Click here to watch their 60-minute webinar on creating accountability, alignment, and moving team members to a culture of “always.”

Let’s say, for example, that one of your hospital’s standards of behavior is “Commitment to Coworkers.” What do those words, “Commitment to Coworkers,” really mean? It may mean that a coworker covered your shift when you were out sick. It may mean that you stayed a few minutes late to accurately and thoroughly explain a patient’s chart to your colleague before you left for the day.

Here are a few tips you can try at your organization to engage staff and keep the standards top of mind.

Roll out the standards in a fun and interactive way. For example, if one of the standards is “Appearance,” host a fashion show to demonstrate what appropriate work attire looks like.
Tie standards into training and development. Try hosting a series of lunch-and-learn sessions around the standard of “Personal/Professional Development.” These sessions provide departmental training in a fun atmosphere and casual luncheon setting.

Make your standards a part of the onboarding and orientation process. For instance, if one of the standards is “Mentoring,” assign each new staff member to a mentor so they have one person to contact for questions in their new role.Every organization is different, and yet, the common thread still remains that the standards are in place not only to make the organization better, but to provide the best possible care to our patients. We have some excellent resources and tips on establishing standards of behavior on our website. To access standards examples from various organizations, click here.

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

High quality healthcare delivery depends on great access to care and information. We know that promoting access into our care and services is requisite to both attaining and retaining patients in a practice. Consumers want to know that they can get care when and where they need it.

Spurred by increased demand resulting from healthcare reform measures, looming workforce shortages, and concerns about access and barriers to care, many leaders are focused on transforming the delivery of healthcare.

New measures evaluating patient access are included in the Clinician and Groups Consumer Assessment of Health Providers and Systems (CG CAHPS) and Patient Centered Medical Home certification process (shown in Table 1) and continue to push for improved access to care, often focusing efforts on same day or timely access.

Element A: Patient-Centered Appointment Access (MUST-PASS)

The practice has a written process and defined standards for providing access to appointments, and regularly assesses its performance on:

“When you phoned this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed”
“When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed?”

To meet the challenges of patient access while maintaining high quality, patient-centered care, here are a few tips that can make a big impact:

Set objective and targeted goals that measure your strategy of success

Many healthcare organizations have learned an important lesson from other service industries and are re-adopting the premise that access and service must be designed from the customer’s perspective. For example, an emerging definition of excellent access is: “The ability of a patient to seek and receive care with the provider of choice at the time the patient chooses.” Coupled with this definition must be metrics that measure and monitor ongoing progress related to patient access. Determine which measures will be used followed by setting targets.

Communicate the strategy of access to providers and staff

Access-related strategies are not likely to be successful if they are not effectively communicated to those who must implement them: the providers and staff. To accomplish this goal, many venues are available to you to ensure the message is heard loud and clear. Utilize employee forums, Leader Development Institutes (LDIs), monthly supervisory meetings, individual rounding on providers and employees, staff meetings, daily huddles, and communication boards to name a few.

When communicating the strategy of access, start with the why. Simon Sinek, author of the book “Start with the Why,” comments that “People don't buy what you do; they buy why you do it. And what you do simply proves what you believe”. When communicating the why supporting your strategy for improved access, clearly articulate that easier access leads to better outcomes.

Train staff to communicate your strategy of access to patients

Begin offering every appointment on the day a patient calls, regardless of the reason for the visit. Consistent with the concept of doing today’s work today, a posture that seeks to provide same day access to patients is not only perceived positively, but it has been found to improve the efficiency of the office. Remember also, if patients do not want to be seen on the day they call, schedule an appointment of their choosing.

Develop Key Words for schedulers to further probe the symptoms and potential urgency of patient complaints. Simply asking the patient if they “would like to be seen today” positions scheduling as a patient centered process and one of great satisfaction to patients.

Subsequent to developing Key Words, maximize validation techniques including real time coaching to support, recognize and continuously improve the skill and competence of scheduling team members. Utilize the framework of AIDET® with specific key words or phrases that comprise the full scheduling script, including the statement, “would you like to be seen today?” When validating, listen to and observe scheduling team members using these key words and capture notes on a standardized validation form allowing for skill assessment and feedback.

The significance of this challenge and more importantly, the impact on quality of care cannot be overstated. Just this week as I was working with a healthcare organization, we learned from a patient the difficulties he is having accessing care. Having recently moved back to his home town, he called to schedule an appointment with a primary care provider and was told it would be several months before he could be seen. Within the same week, he made 2 visits to the local Emergency Department with the second visit resulting in his admission for antibiotics to treat an infection.

While healthcare organizations focus on improving access to care, creating a strategy with inclusion of goals, communication of the why supporting the strategy and communicating to patients the attitude we’ve adopted, “would you like to be seen today?” will lead to better access and health for those we serve.

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to EmCare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

OVERCOMING RESISTANCE TO CHANGE
by Quint Studer

Copyright 2014 by Studer Group, reprinted with permission.

"People wish to be settled; but only as far as they are unsettled, is there any hope for them." - Ralph Waldo Emerson

Being a leader in healthcare is tough. In fact, when you do it right, it feels kind of like you're climbing up a downward moving escalator. (I've actually tried this and it's not easy!)

Yes, we live and work in an ever-changing, fast-paced environment – both externally and internally. In order to make and sustain the improvements necessary to provide the best possible patient care, we often need to adopt new technologies, tools and processes that require us, and our staff, to change the way we do things.

You've probably noticed that people don't always welcome change with open arms. In fact, they resist it. This is natural. However, as leaders we can help people become more comfortable with that “unsettled” feeling.

The first step is to understand the phases of competency and change. At Studer Group, we often use the following model to illustrate the various stages that individuals will find themselves in at some point in their lives and careers.

Phase one: Unconsciously unskilled (incompetent) – During this phase, we are new to a role, process or skill. We don't know what we don't know because it is still too new.

Phase two: Consciously unskilled (incompetent) – In this phase, we consciously know what we don't know. We've identified a gap between our current skill set and where we need to be to become successful.

Phase three: Consciously skilled (competent) – Here we have the skill set, but we still need reminders or checklists to fully execute. We are likely still unsettled, but we understand the need for change and have embraced it.

Phase four: Unconsciously skilled (competent) – It's in this phase that we can complete tasks without reminders. They have become second nature and we can't imagine doing it any other way.

Anytime change is involved, there will be a level of adjustment for both staff and leaders. Part of our job as a leader is to unsettle people. We like to feel successful in our role, but in order to improve we need to be unsettled from time to time.

Realize that discomfort will be associated with change and that's okay. For example, when you ask a high-performing physician to implement a new process, such as electronic medical records, you will likely receive pushback. It's not because they are trying to be difficult, or even because they don't see the benefit. It's because you are asking them to change when they already feel successful.

When you think about this in terms of the four phases of change, you will see that you are actually requiring that physician to move from being consciously skilled back to being unconsciously unskilled.

You can ease anxiety by explaining how this change will make a difference (and for the better!). Describe what the outcome will be after the change is made. This is the why that makes people willing to be unsettled for a while.

Remember, it takes a lot of frequency to become effective and efficient. The phases of competency and change can be a lengthy process. The first six months are by far the hardest and when resistance is at its highest. The next six months are better but some uncertainty may still be present. But by year two, it no longer feels like we've changed; it's simply the way we do things.

Ultimately, change is necessary to standardize leadership, create consistency, and keep ahead of that downward moving escalator. In turn, we produce better outcomes for our employees and our patients.

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

After spiders, snakes and public speaking, people seem most afraid of having difficult conversations. It doesn't matter if the conversation needs to occur with an employee, peer, boss, spouse or child; we all shy away from these critical communications. Why? It's likely because we don't understand the seriousness of biting the bullet and having the conversation and don't have the skills to have these difficult conversations successfully.

At Studer Group®, we have three models for difficult conversations which are part of a leaders' toolkit. The key is to learn about the models, practice them, and pick the appropriate model for the situation. More about that in a minute. First, let's look at why it's so important to have these conversations.

One key to having a difficult conversation successfully is to be a good listener. Studies show us that we spend 9% of our time writing; 15% reading; 35% talking and 40% listening. It's time we focus on learning to listen. We need to listen for the tone of an individual's voice in addition to their words and observe their body language. We need to practice active listening.

Now back to the difficult conversation models. The first difficult conversation model is the Impact Messagedeveloped by Studer Group and my colleague Beth Keane. Beth has shared this model with audiences across the country and talks about it in her popular "Spinach in your Teeth" webinar. There are four steps to this model:

Describe the behavior

Describe the impact

Indicate the desired change

Get a commitment

When using this model for a difficult conversation, it can sound like this:

When you interrupt me while I'm talking...

The result is that I don't feel as if I've been able to explain myself adequately

I need you to let me finish before you respond

Do you agree that you can do this?

This model is ideal for a leader-to-employee conversation, a conversation between a team or committee chair and a member of the committee, or between colleagues.

The second model is "Cup of Coffee Conversations" which is based on research and curriculum developed by the Center for Patient and Professional Advocacy at Vanderbilt University. Although the model was originally developed for conversations with physicians, it is easily adapted to all employee groups and is a conversation that can be held with peers, employees, or even your boss. Many organizations utilize this model and have made it their own, such as "Cup of Tea" or a "Glass of Pop/Soda" conversations.

A "Cup of Coffee Conversation" is typically precipitated when you see or hear a colleague exhibiting behaviors that are contrary to your Standards of Performance or Behavior. This is a conversation that occurs at the time you witness the behavior to make the individual aware that their behavior is not consistent with your standards.

Start by telling them you value them as a colleague or appreciate their skills. Then let them know you heard or saw something that was uncharacteristic and not consistent with your Standards. For example: "Donna, let's go have a "cup of coffee." I noticed that you didn't wash your hands when you entered the patient's room. This doesn't live our values or standards and is concerning to me." Then pause – thus the cup of coffee – and take a sip.

The typical reaction from the person is appreciation for bringing this to their attention. If they deny or justify the behavior, be patient and ask them to "look in the mirror." You're not telling the person they are "bad"; you are merely relating what you experienced.

The third model is the Low Performer conversation. This is part of Studer Group's highmiddlelow® evidence-based leadership tool and is designed for use with someone who persistently demonstrates inappropriate behavior that is inconsistent with policies, procedures, Standards or other work rules. This is a conversation that typically a leader would hold with an employee on their unit or team.

Start the conversation on a serious and professional note. This is probably a conversation you've had with this person before and performance hasn't improved. Then use the DESK model:

D: Describe what has been observed.E: Evaluate how you feel.S: Show what needs to be done.K: Know the consequences of continued same performance.

With proper training and skill building in the non-threatening Leadership Development Institute or team meeting environment, leaders and staff can successfully have difficult conversations using these models. One method for experiential training is to role play in triads with one person being the conversation initiator, one person is the individual you're having the conversation with, and the third person is an observer who provides feedback to the first two people. Then rotate so everyone gets a chance to play each of the three roles. Use real scenarios that individuals in the LDI or team meeting have created. That keeps the conversation focused on real-life situations and makes sure everyone is serious about the skill development.

Difficult conversations can be uncomfortable, but with training and practice, you too can hold difficult conversations – successfully.

To learn more about conducting difficult conversations, including guidelines, tracking logs and more, visit the Tools tab at www.studergroup.com.

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

There’s no substitute for “connecting” with the patient. Effective communication and demonstrating empathy is a critical component to quality patient care. New technologies such as Electronic Health Records (EHRs) can seem like a barrier for physicians and providers looking to build a connection.

According to a New England Journal of Medicine article (Wolpaw, MD, D.R., Shapiro, Ph.D. D; N Engl J Med 2014; The Virtues of Irrelevance 370:1283-1285, April 3, 2014, DOI: 10.1056/NEJMp1315661), personalized opening comments, “convey that we see patients as unique”, “reveal that we have shared experiences”, “are observant and attending to details”, and “indicate that we are open to a conversation.” All of these help to put the patient at ease and establish a therapeutic relationship.

As healthcare is getting even faster paced, and with an increased focus on productivity and utilization of EHR’s becoming the norm, how can we maintain the “connection” in our encounters with patients? As a practicing physician, I personally have been through two EHR implementations in the ambulatory setting, and currently planning for a third (one in inpatient setting and heading for a second), here are a few tips and tricks that can make a big impact:

Briefly review the chart prior to entering the room so the beginning of the encounter isn’t dominated by staring at a screen while rifling through the EHR to find basic information. Be clear on basics of their care, including last visit and needs for this one (prescriptions, referrals, etc.). Make sure the patient’s first and last name are known. If a note was made during the last visit of something special in their life, such as a birthday, wedding, or vacation, ask briefly about it. Patients will be more forgiving when we document in the computer if we’ve already made them feel we’re interested and listening.
Don’t forget your AIDET®.

An important part of AIDET® is the “A” for Acknowledge. This step helps us make a connection to patient. In addition to eye contact, smiling, addressing by name, sitting down, and shaking hands, opening the encounter with a personalized, genuine statement can help make a connection that will make the rest of the encounter more collaborative and satisfying. It can also make the patient more tolerant when we use EHRs.

Include EHR as part of the “Acknowledge” step. State why we use it and how it helps in patient care. Specifically indicate that we will periodically turn to EHR to capture important points for the patient’s shared care plan. When we aren’t documenting in EHR, it’s important to have good eye contact. When we do turn to use EHR, be sure to indicate what you are doing. For example, “Just let me capture that important information”, “Just a moment while I include that in your treatment plan”. Use whatever verbiage and phrasing that feels comfortable while acknowledging the transition to and from the computer.

Don’t forget the “T” in AIDET®: Thank You. Thank the patient for visiting us and close warmly. Don’t let documenting on the computer get in the way of a gracious end to the encounter, complete with eye contact, a hand shake, smile and genuine pleasantry.

Manage up the EHR (or at least don’t manage it down), just as we manage up the rest of the care team. This helps to create overall confidence in the care provided.

A great way to engage patients with the EHR is through the use of graphics and visuals. For well child visits, try showing the growth curve. For chronic disease, show trending graphs for blood pressure, weight, A1Cs, or lipids. This is an excellent opportunity to be transparent with our patients and provide detailed explanations that patients appreciate.

Pay attention to body position in relation to the patient and computer. Is the physical layout of the office conducive so we can sit, talk, and document the encounter with an unobtrusive computer set-up, facing the patient? If not, think about rearranging the room. Consider seating the patient at your EHR station with proximity to both you and the monitor.

Try utilizing a scribe during patient visits. This allows providers to remain solely focused on the patient while the scribe captures plan of care notes in the EHR. Make sure that you inform the patient of the scribes name and role.

As we move into a more electronic age, let’s not lose the connection to purpose and connection to patients. It doesn’t need to add significant time to a visit and can make a big impact. When we connect, the patient feels it, and so do we. It’s equally as good for the patient as it is for the physician. Happier patients lead to happier doctors. It connects to purpose, worthwhile work and why we got into healthcare in the first place. Connecting adds purpose and meaning, for both patient and doctor.